| NPI | 1033104229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009312) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ009132) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2009-06-14 |